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Consolidated Action Plan to Prevent and Combat M/XDR-TB
Consolidated Action Plan to Prevent and
Combat Multidrug- and Extensively
Drug-resistant Tuberculosis in the
WHO European Region 2011–2015
Dr Masoud Dara, Programme Manager, Team Leader
TB/MDR-TB
WHO Regional Office for Europe
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Outline of the presentation
• TB and MDR-TB situation in the WHO European Region
• Key challenges in prevention and control of M/XDR-TB
• The Consolidated Action Plan to Prevent and Combat M/XDR-TB in a nutshell (MAP)
• The WHO Regional Committee for Europe resolution on M/XDR-TB
• TB in children in MAP
• Next Steps
Consolidated Action Plan to Prevent and Combat M/XDR-TB
TB burden in the Region
53
74
0
20
40
60
80
100
AFR AMR EMR EUR SEAR WPR Global
%Case detection rate ,
WHO Regions, 1990 and 2010
1990
2010
68 68
0
20
40
60
80
100
AFR AMR EMR EUR SEAR WPR Global
% Treatment success rate, WHO Regions, 1995 and 2009
1995
2009
Treatment success rate (TSR) among laboratory-confirmed new
pulmonary TB cases, WHO European Region, 2009
TSR (data available on 09.10.2011)
Consolidated Action Plan to Prevent and Combat M/XDR-TB
MDG 6c: Tuberculosis Notification rate; WHO European Region, 1980-2010
34.61
71.6
4.9
0
20
40
60
80
100
1980 1985 1990 1995 2000 2005 2010
per
10
0 0
00
po
pu
lati
on
Notification rate, European Region
Notification rate, 18 high priority countries *
Notification rate, 27 EU countries **
Note: ** excluding Bulgaria and Romania entering to EU in 2007
Armenia
Azerbaijan
Belarus
Bulgaria
Estonia
Georgia
Kazakhstan
Kyrgyzstan
Latvia
Lithuania
Moldova
Romania
Russian Fed.
Tajikistan
Turkey
Turkmenistan
Ukraine
Uzbekistan
* 18 high priority
countries
Source: Global tuberculosis database, WHO. Accessed on 10 October 2011
Consolidated Action Plan to Prevent and Combat M/XDR-TB
• Estimates: 420 000 new TB and 62 000 deaths (47 and 6,9 per
100 000 respectively).
• the WHO European Region has the highest case detection
rate worldwide (79%)
• Notifications: 329 391 new TB and relapses and 46 241 TB patients
died (36,8 and 6,1 per 100 000 respectively).
• The vast majority of them in the eastern and central part of the Region,
(87% of the incidence and 92% of the mortality) – 18 high
priority countries for Stop TB in the Region
• The Region has the lowest treatment success rate
worldwide:
– 68% among new pulmonary TB infectious patients and
– 48% among patients that had been previously treated
8076
88 8893
5
5
3 4
2
2
1
12
1
6
8
55 17
10
3 1 3
40%
50%
60%
70%
80%
90%
100%
AFR AMR EMR SEAR WPR
Not evaluated Defaulted Failed Died Successfully treated
68
48
8
11
12
23
7
11
5 7
New pulmonary lab.confirmed
Re-treatedlab confirmed
Treatment outcomes of New pulmonary
laboratory confirmed in other WHO regions, 2009
Treatment outcomes, European Region
2009 (provisional data)
Source: the Global TB control 2011 report Source: the Global TB control 2011 report
Consolidated Action Plan to Prevent and Combat M/XDR-TB
MDR-TB burden, 2009
• 15 out of 27 high-MDR-TB burden
countries in the WHO European Region
(81 000 patients annually)
• In 2009, only 27 765 MDR-TB patients
notified (1/3 of estimates) due to limited
access to diagnosis
• Treatment success rate of MDR-TB cohort
in the Region 57.4% only
Source: M/XDR-TB: 2011 global report (WHO/HTM/TB/2011.3)and TB surveillance in Europe, report 2009
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Key challenges in prevention and control
of M/XDR-TB
• Health system failure to prevent emergence and spread of drug- resistant TB
– Late diagnosis of TB and M/XDR-TB
– Inadequate treatment of TB and subsequent acquired resistance
– Poor infection control and contact tracing
• Insufficient capacity to treat M/XDR-TB patients
– Models of care not cost-effective, nor patient friendly
– Difficult access to expensive second-line drugs
– Lack of new medicines
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Consolidated Action Plan to Prevent and
Combat M/XDR-TB
• No business as usual (Special Project of the Regional
Director)
• Inclusive approach to develop the Plan
• Building on the existing commitments (from Berlin to
Beijing and Baku)
• SMART objectives, clear list of activities
• Full endorsement at 61st Regional Committee in Baku
• Fully costed / includes financial gap analysis
• Follow-up mechanism
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Goal • To contain the spread of drug-resistant TB by achieving
Universal Access to prevention, diagnosis and treatment
of M/XDR-TB in all Member States of the WHO European
Region by 2015
Targets
• To decrease by 20 percentage points the proportion of MDR-TB among previously treated patients by end 2015
• To diagnose at least 85% of estimated MDR-TB patients by 2015
• To treat successfully at least 75% of notified MDR-TB patients by 2015
Goal and Targets of MAP
Consolidated Action Plan to Prevent and Combat M/XDR-TB
What is new in MAP?
• Prompt diagnosis including newly endorsed
molecular diagnostic techniques
• Equitable access to adequate treatment
• Health system approach to MDR-TB
prevention and control
• Emphasis on involvement of civil society
organizations
• Identifying and addressing social
determinants
• Working in partnership, twinning of
cities/programmes
• Robust monitoring framework, accountability
and follow-up
• Including neglected aspects (e.g. TB in
children, palliative care, surgery)
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Expected achievements of MAP
• 225 000 MDR-TB patients
diagnosed
• 127 000 MDR-TB patients
treated successfully
• 250 000 MDR-TB cases
averted
• 13 000 XDR-TB cases
averted
• 120 000 lives and 12 US$
billion saved
75,436 71,478
28,887
60,756
17,913
60,756
10512
45567
2011 2012 2013 2014 2015
Expected achievements due to the implementation of the action plan, 2011– 2015
Estimated MDR-TB casesemerging
MDR-TB cases,detected
MDR-TB patientsenrolled ontreatment
MDR-TB patientssuccesifullytreated
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Areas of intervention
• Identify and address social determinants, improve adherence to treatment, improve health financing and involved primary health care services
1. Prevent the development of M/XDR-TB
• Strengthen TB laboratory network, facilitate introduction of new diagnostic technologies, break system barriers to access
2. Scale up access to early diagnosis
• Ensure sufficient quantity of quality second line drugs, improve management of adverse reactions and promote production of new drugs
3. Scale up access to effective treatment
• Assess, plan and improve airborne infection control in health care and congregate settings
4. Scale up TB infection control
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Areas of intervention (cont.)
• Electronic recording and reporting, improve quality of data and capacity to use data
5. Strengthen surveillance
• Adapt new policy guidance, improve human resources, foster partnership and coordination, ensure ethics and human rights
6. Expand management capacity of the programmes
• Ensure TB/HIV collaborative activities, specific action for children, prisoners, migrants and hard-to-reach populations
7. Address the needs of special populations
Consolidated Action Plan to Prevent and Combat M/XDR-TB
WHO Regional Committee resolution on M/XDR-TB adopts the Consolidated Action Plan and
Urges Member States
• to harmonize as appropriate their
national health strategies and/or
TB/MDR-TB response plans based on
the Regional Plan
• to identify and address determinants
and health system challenges leading
to emergence of drug-resistant TB
• to provide universal access to early
diagnosis and effective treatment of
MDR-TB patients
• to address the needs of special
populations
• to closely monitor and evaluate
implementation of the actions outlined
in the Action Plan
Requests the Regional Director
• to provide leadership, strategic
direction and technical support for
implementation of the Action Plan
• to facilitate the exchange of
experiences and know-how among
Member States
• to establish a platform to strengthen
partnership for prevention and control
of TB and M/XDR-TB
• to assess progress in the prevention
and control of M/XDR-TB every other
year starting from 2013 and report
back to the Regional Committee
Primary Health Care, Psycho-social Support, Health Financing
Consolidated Action Plan to Prevent and Combat M/XDR-TB
TB in children and MAP
• Activity 7.3.1 The Member States will accelerate the adoption
of updated childhood TB guidelines by mid-2012.
• Activity 7.3.3 The Member States will include and prioritize
childhood TB in their national TB strategic or national health
plans by the end of 2013.
• WHO/Europe Task Force on TB in children
– Build a core group of experts with consensus on TB in
children
– Provide the Member States with the technical assistance
– Improve surveillance
• A Regional training and workshop is planned for the first quarter
2012
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Launch of MAP
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Next steps
• Comprehensive national MDR-TB response plans in line with
MAP in 2012
• Health system audits to identify bottlenecks and propose
solutions
• Facilitate diverse models of technical assistance
• High Level visits to ensure commitment to implementation of
MAP
• Yearly progress report (WHO/ECDC annual monitoring &
surveillance report)
• Interagency steering group involving civil society organizations
for follow-up of MAP
Consolidated Action Plan to Prevent and Combat M/XDR-TB
Thank you very much for your attention